Laxative misuse in patients with eating disorders

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Laxatives have been used for health purposes for over 2000 years. These days they are most commonly used in clinical practice for patients who struggle with poor gastrointestinal (GI) transit and chronic constipation. However, they are often misused by patients with eating disorders in an attempt to move food through the body more rapidly and not absorb calories from the natural diet. This not only likely does not significantly prevent calorie absorption but may also cause medical complications. Proper education about use of bowel laxatives is important, and knowing the signs of misuse in oneself or in others is also important.

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In this article

What are laxatives?

laxatives are a class of medications that promote emptying of the GI tract. There are several types of laxatives. Some of them are stimulant agents. Some are saline and osmotic agents. Some are bulking agents. And some are surfactants. It’s usually the stimulant agents that are used in laxative abuse. (1) 

Laxatives stimulate the large intestine to release its contents. In that area of the GI tract, there are a lot of things going on. Your whole GI tract is an amazing factory and each part of it has a major function. In the large intestine, there is reabsorption of water, minerals and electrolytes. You need these to survive. 

Thus, if you use a laxative over and over again, you end up depleting yourself of the minerals and electrolytes. You end up dehydrating yourself. And in the process, some pretty bad symptoms show up:

  • Bloating
  • Gas
  • Diarrhea
  • Vomiting
  • Weakness
  • Blurred vision
  • Fainting
  • Weakness
  • Heart arrhythmia 
  • Abdominal pain
  • Dehydration
  • Mood swings
  • Depression

Rates of use of excessive laxative use

The prevalence of excessive laxative use, or laxative abuse, has been reported to range from ten to sixty percent of those with anorexia nervosa (AN) or bulimia nervosa (BN). (1)

Myths about laxative misuse

Excessive laxative use won’t help you lose weight any faster. The food that is inside the GI system passes through the body and is transient. Every time you eat, the new food replaces the old. So if you’re concerned about only a temporary fluctuation in weight, laxatives will do the job – but they will never give you the long term weight loss you want. Using laxatives for weight loss is ineffective and not medically advisable.

What effects laxative abuse has on your body 

Too many bowel movements or too few bowel movements can cause health problems. Too many bowel movements strip the electrolytes out of the body and causes pH changes that can lead to poor absorption, GI symptoms and poor nutrition over time. Too few can cause poor transit, bloating, pressure and pain.

Risks of laxative abuse 

Laxatives overuse and abuse can have medical risks. Overuse of laxatives can lead to dehydration, electrolyte imbalances, and depletion of essential elements of the GI tract that can cause chronic diarrhea, malabsorption and nutritional deficiencies in the future. Stimulant laxatives can also cause rebound edema (swelling) that can be quite severe. If someone is using laxatives regularly and then suddenly stops, the sodium and free water shifts that occur in the body will cause the production of swelling and severe edema. At that point in time, patients may require diuretics and possibly inpatient or more intense management to correct the situation. (5)

Laxative abuse is also associated with poor mental health outcomes:  in patients with eating disorders has been associated with suicide attempts, impulsivity, longer duration of illness, greater severity of eating disorders, higher prevalence of borderline personality disorders. (2)

Eating disorder/laxative use disorder treatment 

Eating disorder treatment is available and can be very effective for individuals misusing laxatives  There are not any medications that specifically treat eating disorders, and so most treatment revolves around behavioral interventions, psychosocial support, and therapy. 

Therapy can help us look at our beliefs, attitudes and behaviors around food and change the behaviors that do not serve us and emphasize the behaviors that do serve us for the better. P can be an immense aid to your overall emotional growth and maturity.

One particular type of therapy is called Cognitive behavioral therapy, or CBT. CBT has been shown to treat eating disorders effectively by correcting the distorted way of looking at the body, the thinking processes and the behaviors surrounding maladaptive food habits. (6) A review of the literature shows that this type of therapy is more effective in treating eating disorders than other traditional approaches and is thus usually the treatment of choice for eating disorders. (6)

Treatment for laxative abuse includes education, discontinuation of laxatives, medical follow-up and psychotherapy, particularly CBT. (4) There are other comprehensive type of and holistic therapies that addresses nutrition including meditation and mindfulness, group therapy, acupuncture, herbal medicine, among others; your multi-disciplinary team can help you pursue specific treatments that might benefit you in your recovery from a laxative related eating disorder.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Roerig JL, Steffen KJ, Mitchell JE, Zunker C. Laxative abuse: epidemiology, diagnosis and management. Drugs. 2010 Aug 20;70(12)1487-503. https://pubmed.ncbi.nlm.nih.gov/20687617/ 
  2. Tozzi, F, et al. Features associated with laxative abuse in individuals with eating disorders. Psychosom Med. May-Jun 2006;68(3):470-7. https://pubmed.ncbi.nlm.nih.gov/16738081/ 
  3. Pryor T, Wiederman MW, McGilley B. Laxative abuse among women with eating disorders – an indication of psychopathology? Int J Eat Disord. 1996 Jul;20(1):13-8. 
  4. Vanin JR, Saylor KE. Laxative abuse: a hazardous habit for weight control. J Am Coll Health. 1989 mar; 37(5):227-30. 
  5. Ragunathan A, Singh P, et al. Laxative abuse cessation leading to severe edema. Cureus. 2021 Jun 23;13(6):e15847. 
  6. Yeh HW, Tzeng NS, Lai TJ, Chou KR. Cognitive behavioral therapy for eating disorders. Hu Li Za Zhi. 2006 Aug;53(4):65-73.

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